Join the Summit GET INVOLVED IN NAIIS Name* First Last Credentials ie. MD, Pharm D, MPH, etc.Employer* Organization Represented (If different from employer) If not employerTitle* Organizational Category*Please select a categoryAdvisory Group or Committee (Please specify below)Advocacy Group (please specify your audience)Association for Healthcare Professionals (specify on next dropdown menu)CoalitionCommunications and/or education and/or marketingHealth Plan/InsuranceHealth clinic, system or hospitalLong-term care facility or organization for care of older adultsMilitarySchools, Colleges, or UniversitiesState and Local Public HealthUS Government AgenciesVaccine DistributorVaccine ManufacturerBusiness supporting vaccination other than vaccine manufacturers or distributorsOther, please specify belowOther organizational category* Please fill this out if you selected "Other" from "Organizational Category" above. Advisory Group Or Committee* Specify which advisory group or committee you representAdvocacy Group or Committee Audience* Please specify the audience for your advocacy group or comittee.Association for Healthcare Professionals (select one)*Please select an AssociationNurse or nursing or physician assistant organizationPediatric provider or pediatric provider organizationPharmacy or pharmacist organizationFamily physician or family medicine organizationInternal medicine or internal medicine organizationObstetrician, Gynecologist, or Nurse Mid-Wife organizationOther healthcare professional organization type (please specify below)Please fill out if you selected "Association for Healthcare Professionals" under Organizational CateogryOther association for healthcare professionals* Please fill out if you selected "other healthcare professional association type" above.Email* Enter Email Confirm Email Phone*FaxAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Δ